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Balancing Value & Burden:
CMS Electronic Quality Reporting
Session #199, February 14, 2019
Michelle Schreiber, MD, Director, Quality Measurement and Value-Based Incentives Group
Debbie Krauss, MS BSN RN, Nurse, Division of Electronic and Clinician Quality
The Center for Clinical Standards & Quality, Centers for Medicare & Medicaid Services
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Michelle Schreiber, MD
Centers for Medicare & Medicaid Services
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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Debbie Krauss, MS BSN RN, Nurse
Centers for Medicare & Medicaid Services
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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Introduction
eCQM Strategy Project
Timeline of Activities
Approach to Learn Stakeholder Experiences
Overview of Burdens and Recommendations
Initiatives underway to increase value and reduce burden
Collaborative Measure Development Workspace
Data Element Repository
Demonstration
Resources
Question & Answer Session
Agenda
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Learn how CMS has engaged with stakeholders to understand the
burden associated with measure implementation and electronic
quality reporting.
Identify initiatives underway to increase the value and reduce
burden associated with measure development, implementation,
and reporting.
Understand how the Collaborative Measure Development
Workspace can help improve value through increased stakeholder
engagement and transparency into the development process.
Learning Objectives
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Primary goal of Administration:
Remove obstacles that get in the
way of the time clinicians spend
with their patients
Patients Over Paperwork
Shows CMS’s commitment to
patient-centered care and
improving beneficiary
outcomes
Includes several major tasks
aimed at reducing burden for
clinicians
Motivates CMS to evaluate its
regulations to see what could
be improved
Introduction
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What is Meaningful Measures Initiative?
Launched in 2017, the purpose of the Meaningful Measures
initiative is to:
Improve outcomes for patients
Reduce data reporting burden and costs on clinicians and other
health care providers
Focus CMS’s quality measurement and improvement efforts to
better align with what is most meaningful to patients
A New Approach to Meaningful
Outcomes
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Problem Statement
Providers participating in CMS quality and value-based
purchasing programs have shared challenges they experience
related to the complexity and high burden of electronic
clinical quality measure implementation, data capture, and
reporting.
Project Scope
Measure Development process from concept to the MUC list
Electronic Clinical Quality Reporting requirements and
processes from eCQM implementation to submission
Tools for Development and Reporting
eCQM Strategy Project
Problem Statement and Project Scope
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eCQM Strategy Project
Timeline and Activities
October 2017
November 2017
Project Started
Environmental Scan
Completed
User-Centered Design
Team Training
Stakeholder
Engagement Planning
December 2017
March 2018
Stakeholder Events
Site Visits
ONC Annual Meeting
CMS Quality
Conference
HIMSS 2018
Conference
April 2018 June 2018
Findings and
Recommendations
Compiled
Socialization of
Recommendations
with CMS Quality Staff
and Leadership
July 2018 Present
Implementation
Planning Discussions
with CMS, Contractor
Staff, and External
Partners
Collaborative Measure
Development
Workspace Planning
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Training completed by User-Centered Design Experts
Focus on engaging directly with hospitals, providers, and
other stakeholders to:
Hear their experiences
Understand what is working well
Understand where there are opportunities for
improvement
Journey mapping to visualize the provider processes and
help identify gaps, moments of frustration/delight, etc., and
thus lead to insights for improvement
eCQM Strategy Project
Approach to Learn Stakeholder Experiences
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Engaged with the following stakeholders:
Clinicians
Hospitals
Measure developers
Health IT vendors
Data submission vendors
CMS measure, policy-related, & Information Systems Group (ISG)
staff
ONC
Engagement venues: site visits, listening sessions, face to face
discussions at CMS, CMS Quality Conference, ONC Annual Meeting, and
HIMSS 2018
Focus on experiences and processes of stakeholders
Review of current state processes within CMS
eCQM Strategy Project
Approach to Learn Stakeholder Experiences
Walters Wiggles ZION
“I think I can, I think I can!?!?!?”
Success!! The Relaxing Descent
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eCQM Strategy Project
Approach to Learn Stakeholder Experiences
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Happy with the work: given green light across the board to implement
recommendations
Implement a user-centered design focus is essential in all efforts
Collaborate and convene with stakeholders and across programs for data
submission which will result in most efficient and effective processes
Work collectively across CMS groups to breakdown barriers and achieve
aligned goals
Conduct continuous improvement for communication, education, and
outreach to ensure stakeholders can easily understand program
requirements
eCQM Strategy Project
General Recommendations from CCSQ Leadership
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Measure Development
Convened a working session in September with measure development
stakeholders to review related recommendations
Measure developers launched initiative to increase focus on clinical
workflows
Exploring value and expanded use of hybrid measures, which are
clinical quality measures that link patient-level electronically specified
EHR data to CMS claims data for the purpose of enhancing risk
adjustment.
Measure Implementation and Reporting
Measure-level webinars planned for both Eligible Clinicians and
Eligible Hospitals to kicked off in October and run through February
Convened a CMS working session in October to discuss CMS
program opportunities
Planned Collaborative Measure Development (CMD) Workspace
Improvements to Inpatient Quality Reporting System are in progress
eCQM Strategy Project
Progress on Implementing Recommendations
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Follow-up with External Groups
Held discussions with non-CMS organizations to share
recommendations that were within their respective oversight. Those
organizations include:
Health IT Vendors
National Library of Medicine/Value Set Authority Center
National Quality Forum
Electronic Health Records Association
CMS Activities to Support Implementers
Working on improvements to QPP and IQR Help Desks
Delivered webinars to assist providers with understanding program
requirements, Quality Reporting Document Architecture (QRDA)
Implementation Guide and troubleshooting, eCQM data validation,
available tools and resources, and Pre-Submission Validation
Application (PSVA) overview
eCQM Strategy Project
Progress on Implementing Recommendations (Cont.)
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Burden Reduction Using Electronic Data
CCSQ is testing Fast Healthcare Interoperability Resources
(FHIR®) for Quality Measurement
Da Vinci Project
Alignment with the community around adoption of FHIR,
including Providers, ONC, Health IT Vendors, Payers
HL7 Connectathons
Testing the submission of quality data using FHIR
Testing the calculation of eCQMs using FHIR
Application Programming Interfaces (API) to create a
seamless exchange of quality data from an EHR
FHIR-based Certification processes and tools
eCQM Strategy Project
What’s new for Measure Development,
Implementation, & Reporting?
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Live on
December 28, 2018
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Hosted on the Electronic Clinical Quality Improvement (eCQI)
Resource Center
Set of interconnected resources, tools, and processes for eCQMs
Promotes transparency and better interaction across stakeholder
communities interested in developing and implementing more
harmonized, accurate, and meaningful electronic clinical quality
measures.
Provides access to the eCQM Data Element Repository, an
online, searchable tool that provides all the data elements
associated with eCQMs used in CMS Quality Reporting
Programs.
CMD Workspace: Definition
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Demonstration
https://ecqi.healthit.gov/collaborative-
measure-development
Collaborative Measure Development
Workspace
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Debbie Krauss, MS BSN RN, Nurse,
Centers for Medicare & Medicaid Services
Deborah.Krauss@cms.hhs.gov
To share feedback or get involved, please email:
eCQMStrategy@groups.mitre.org
Please don’t forget to complete your session evaluation.
Questions?
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Backup Slides
Collaborative Measure Development
Workspace
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